| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
279 |
122 |
$22K |
| D1110 |
Prophylaxis - adult |
700 |
694 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
581 |
576 |
$10K |
| D0330 |
Panoramic radiographic image |
276 |
274 |
$10K |
| D0274 |
Bitewings - four radiographic images |
808 |
796 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
564 |
559 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
289 |
289 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
41 |
19 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
138 |
134 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
458 |
454 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
404 |
221 |
$1K |